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Outpatient dialysis clinics will receive direct federal allocations of COVID-19 vaccine for their dialysis patients and staff, the and the .

CDC's partnership with the two largest dialysis providers, DaVita and Fresenius Medical Care North America, will use the companies' distribution networks to allocate vaccine to smaller networks and independent dialysis clinics across the country as well.

Allocations are expected to begin on Monday, March 29 to Fresenius, DaVita, and clinics that already have agreements with them in place. Vaccinations should start the same day.

"We have been planning for a possible national rollout for months by consenting patients in advance, creating policies and procedures around the distribution and handling of vaccine, as well as implementing new software to effectively track all doses administered," said a spokesperson for Fresenius. "These systems have worked well in states that already allocated vaccine to dialysis centers, and we expect to begin vaccinating all patients in a matter of days, including more rural locations."

For the limited number of states that had already had arrangements with dialysis clinics, allocation through the state, rather than the federal, government will continue for the few cases where it's working well with sufficient supply, said Jeffrey Silberzweig, MD, medical director of dialysis services for NewYork-Presbyterian Hospital/Weill Cornell Medical Center and Lower Manhattan Hospital.

More typically, though, states have been running the "last mile" distribution by prioritizing mass vaccination centers. In Pennsylvania, for example, the state health department last week changed its policy to prioritize mass vaccination sites, cutting off many physician offices and pharmacies.

The change is "exactly what we lobbied them for," said Silberzweig, who was involved in those negotiations as co-chair of the American Society of Nephrology's COVID-19 Response Team.

Concerted effort among professional organizations and dialysis providers to get vaccine allocation to dialysis clinics started last year with lobbying at both the state and federal levels. Silberzweig chalked their success up to two factors: a new administration in the White House willing to listen and expanding vaccine supplies.

"We can't be more clear -- federal vaccine allocation for ESRD [end-stage renal disease] patients at dialysis clinics will save lives," said a statement from the American Kidney Fund.

The effect will be immediate, predicted its president and CEO, LaVarne Burton. "The providers have said they can get this done in a very short time," using all their allocated doses within a week of receiving it, she said, although just how many doses will be sent over what period of time for the some 500,000 dialysis patients nationwide remains unclear.

While high-risk adults are now in nearly every state, an estimated 75% of dialysis patients have not yet been vaccinated, Silberzweig said, based on a call yesterday among chief medical officers for clinics around the country.

And only 35% of healthcare workers in dialysis centers have been vaccinated, CDC Director Rochelle Walensky, MD, MPH, noted in a statement.

There are plenty of reasons to expand vaccination to this high-risk group of patients and to use the dialysis clinics to do so.

"Dialysis care providers have longstanding experience administering flu and hepatitis B vaccinations to people who receive dialysis treatment," Walensky pointed out. "They also have extensive operational, logistical, and information-technology infrastructure to support COVID-19 vaccinations."

"Importantly, this effort will allow people who receive dialysis treatments to receive a COVID-19 vaccine from a trusted, trained, and familiar source at a location they already visit several times each week," she added.

It's also a step in the right direction on vaccine equity, "as more than half our patients identify as ethnic minorities and the majority are older patients who face hurdles including digital literacy and transportation that make other vaccine distribution models ineffective for this group," said Fresenius CEO Bill Valle in a statement.

Also, direct access to the shot "in a convenient and trusted site of care" should reduce vaccine hesitancy rates, DaVita said in a attributed to CEO Javier Rodriguez.

Overcoming vaccine hesitancy has been something Silberzweig has seen already at the nine dialysis units he oversees as chief medical officer of the Rogosin Institute in New York City, after they started getting vaccine allocations through the affiliation with NewYork-Presbyterian.

"Our patients are very similar to the general population," he told 番茄社区. "When we started the vaccination program last week, there were a good number of patients who were hesitant. But then they saw other patients and staff getting vaccinated, and most of that hesitancy has gone away, so that the great majority of patients and staff in all of our facilities have been vaccinated."

Of course, there are many other high-risk patient groups out there, Burton noted. They also need to be singled out for immediate access without having to fight for vaccination slots and jump technologic hurdles, she said. "We need to eliminate barriers."

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